SB 855 2020
#Substance Abuse Treatment
SB 855 requires insurance companies to expand the definition of Mental Health to include Substance abuse and cover as any other illness. Learn More — Bill Summary
(2) “mental health and substance use disorders” means a mental health condition or substance use disorder that falls under any of the diagnostic categories listed … Diagnostic and Statistical Manual of Mental Disorders.
(g) This section shall not apply to accident-only, specified disease, hospital indemnity, Medicare supplement, dental-only, or vision-only insurance policies. Autism 7.1.2012 SB 946 §10144.5.
Plans must cover out-of-network services based on billed charges (rather than a discounted allowed amount or negotiated price) immediately if the plan was not able to provide in-network services in a timely manner based geographic access and timeliness requirements. CA Health Line *
Links & Resources
- Using Health Insurance to Attend Drug Treatment in California
- Blue Shield Summary & FAQ’s *
- CA Insurance Commissioner letter to All Health Insurance Companies to comply with SB 855 to provide coverage for medically necessary treatment of mental health and substance use disorders, as defined, under the same terms and conditions applied to other medical conditions.
- magellan provider focus.com/what-you-need-to-know-about-senate-bill-855
- Analysis of California Senate Bill 855 Health Coverage: Mental Health or Substance Abuse Disorders 104 pages report to State Legislature
- aacap.org/Medical_Necessity_Criteria
- Treatment Guidelines: Substance Use Disorders
- PRACTICE GUIDELINE FOR THE Treatment of Patients With Substance Use Disorders Psychiatry Online . org 276 pages
- Magellan’s Adopted Clinical Practice Guidelines For the Assessment and Treatment of Patients With Substance Use Disorders
- Fact Sheet SB 855 5 pages Senator Scott Wiener
- Treatment Guidelines: Substance Use Disorders
- medicare.gov/ mental-health-substance-use-disorder-services
- medicare advocacy.org/coverage-of-mental-health-services/
- Medicare Coverage of Substance Abuse Services MLN
- Parity of Mental Health and Substance Use Benefits with Other Benefits: Using Your Employer-Sponsored Health Plan to Cover Services dol.gov pdf
- Understanding Your Mental Health and Substance Use Disorder Benefits dol.gov
- Mental health and addiction care kaiser.org
FAQ’s
Substance Abuse Treatment
- Question My son lives in California and has medi – cal age 28 yrs. He has dual diagnosis mental health and substance use, it’s almost impossible to get him into a residential rehab because most places don’t take medi cal.
- Is there any affordable extra insurance we can get for him in this particular area.
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- Is there any affordable extra insurance we can get for him in this particular area.
- Answer
- You could pay full price – no subsidies as they are not available if you qualify for Medi Cal for an Individual Plan.
- See information below on Medi Cal coverage and how to appeal.
- What Medi Cal Insurance Company HMO is he in?
- Did you check with them?
- medicaid.gov/substance-use-disorders
- LA Public Health Substance Abuse
- Here’s what I found in Google on Treatment Centers that take Medi Cal.
- FAQs / Ask Us a Question
. - Ok so my homeless friend has Medi Cal. Let’s say we got him a blue shield ppo in addition. I realize that it will be expensive but my question is how will it work.
- 1. Let’s say he went to a $50,000 inpatient place and insurance covered 10%. So we would be responsible for the remaining amount or only up to a certain amount?
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2. What if he goes to the hospital would Medi-cal cover his stay or no because he has other health care.
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3. We would really like to help him out but I get different answers from different people. I apologize if you already answered. I will read through when I get time.
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- Get quotes for Blue Shield PPO
- # 1 your question sounds good, but doesn’t make sense. How would the Insurance only pay 10%? Are you talking about the Blue Shield PPO or Medi Cal?
- Private Insurance pays first. Then if you are using a Medi Cal provider, Medi Cal would pay.
- Our webpage on Medi Cal & Dual Coverage
- # 2 See above.
- # 3, that’s why I only give answers with a citation and don’t take phone calls.
- Private Insurance pays first. Then if you are using a Medi Cal provider, Medi Cal would pay.